<!DOCTYPE html>
<html>
	<head>
		<meta charset="UTF-8">
		<title></title>
	</head>
	<style type="text/css">
		.admin_2{width: 100%;height: 100%;font-weight: 300;}
		.admin_2_1,.admin_2_2,.admin_2_3{width: 760px;height: 330px; margin: 0 auto;/*border: dashed 1px #006DCC;*/margin-top: 25px;}
		.admin_2_1_1{float: left;width: 250px;font-size: 27px;}
		.admin_2_1_2{float: right;width: 500px;/*border: solid 1px #000000 ;*/}
		.admin_2_1_2 input{display: inline-block;}
		.admin_2_2_1{float: left;width: 250px;font-size: 27px;}
		.admin_2_2_2{float: right;width: 500px;/*border: solid 1px #000000 ;*/}
		.admin_2_2_2 input{display: inline-block;}
		.admin_2_3_1{float: left;width: 250px;font-size: 27px;}
		.admin_2_3_2{float: right;width: 500px;/*border: solid 1px #000000 ;*/}
		.admin_2_3_2 input{display: inline-block;}
		.admin_2_1_2>p{margin-bottom: 17px;}
		.admin_2_2_2>p{margin-bottom: 17px;}
		.a-upload1,.a-upload2,.a-upload3,.a-upload4 {
    padding: 7px 26px;
    height: 34px;
    line-height: 20px;
    position: relative;
    cursor: pointer;
    color: #666;
    background: #fafafa;
    border: 1px solid #ddd;
    border-radius: 4px;
    overflow: hidden;
    display: inline-block;
    *display: inline;
    *zoom: 1
}

.a-upload1  input,.a-upload2  input,.a-upload3  input,.a-upload4  input {
    position: absolute;
    font-size: 100px;
    right: 0;
    top: 0;
    opacity: 0;
    filter: alpha(opacity=0);
    cursor: pointer
}

.a-upload1:hover,.a-upload2:hover,.a-upload3:hover,.a-upload4:hover {
    color: #444;
    background: #eee;
    border-color: #ccc;
    text-decoration: none
}
#body_right{overflow: auto;}
#title span{line-height: 67px;display: inline-block;}
		/*#title span:nth-child(2){margin-right: 20px;margin-left: 20px;}*/
		/*#title span:hover{border-bottom: solid 4px #000000;cursor:pointer}*/
		/*#title span:nth-child(1){border-bottom: 4px solid #000000;}*/
		.panel-default > .panel-heading {
    color: #333;
    background-color: rgb(237,240,242);
    border-color: #ddd;
}
.panel-title > a {
    display: block;
    line-height: 42px;
    padding-left: 15px;
    text-decoration: none;
    font-size: 14px;
}
.panel-heading{padding: 1px 10px;}
.panel-title{color: #3d5159;}
.panel-group .panel{border-radius: 0;border-left: none;border-right: none;border: none;}
.admin_2 td{border: solid .5px #E3E3E3;border-left: none;border-bottom: none;font-weight: 400;color: #636363;font-size: 14px;}
.admin_2 td>input{font-weight: 400;font-size: 14px;display: inline-block;}
table{width: 94%;line-height: 50px;margin-left: 3%;}
.tbody>tr>td:nth-child(1){border: solid .5px #E3E3E3;border-bottom: none;}
#accordion>p{font-size: 16px;margin: 15px 0;color: #565656;font-weight: 400;}
.tbody td>span{position: relative;top: 11px;line-height: 10px;color: #a94442;font-size: 28px;}
.tbody tr:last-child td{border-bottom: solid .5px #E3E3E3;}
.tbody select{background-color: #fff;border: solid .5px #d9d9d9;width: 265px;margin-left: 10px;height: 34px;}
.a-upload1, .a-upload2, .a-upload3, .a-upload4{display: inline;}
.tbody p {margin: 7px 0 7px 10px;}

		#title span{line-height: 76px;display: inline-block;padding: 0 28px;}
		#title span:nth-child(2){}
		#title span:hover{background-color: #f7f9fa;cursor:pointer}
		#title span:nth-child(1)>d{border-bottom: 4px solid #000000;display: inline-block;line-height: 68px;}
	</style>
	<body>
		<div class="admin_2">
			<form enctype="multipart/form-data" action="" method="post">
				<div class="panel-group" id="accordion" role="tablist" aria-multiselectable="true">
  <!--<div class="panel panel-default" style="margin-bottom: ;">
    <div class="panel-heading" role="tab" id="headingOne">
      <h4 class="panel-title">
        <a role="button" data-toggle="collapse" data-parent="#accordion" href="#collapseOne" aria-expanded="true" aria-controls="collapseOne">
          基本信息
        </a>
      </h4>
    </div>
    <div id="collapseOne" class="panel-collapse collapse in" role="tabpanel" aria-labelledby="headingOne">
      <div class="panel-body">
        <div class="admin_2_1" style="margin-top: 50px;">
				<div class="admin_2_1_1">
					<p>公司信息</p>
				</div>
				<div class="admin_2_1_2">
					<p>公司名称 <input type="text" name="companyName" class="form-control" id="exampleInputEmail1" placeholder="公司全称" style="width: 330px;margin-left: 48px;"></p>
					<p>公司注册地址 <img data-toggle="tooltip" name="companyURL" data-placement="left" data-original-title="公司注册地址参见「公司营业执照」里的「住所」一项！"  src="img/sl24.svg"/> <input type="text" class="form-control" id="exampleInputEmail1" placeholder="公司注册地址" style="width: 330px;"></p>
					<p>公司联系地址 <input type="text" name="companyURL2" class="form-control" id="exampleInputEmail1" placeholder="公司联系地址" style="width: 330px;margin-left: 20px;"></p>
					<p>公司联系人 <input type="text" name="companyContact" class="form-control" id="exampleInputEmail1" placeholder="公司联系人" style="width: 330px;margin-left: 34px;"></p>
					<p>公司邮箱 <input type="email" name="companyEmail" class="form-control" id="exampleInputEmail1" placeholder="公司邮箱" style="width: 330px;margin-left: 48px;"></p>
					<p>客服电话 <input type="number" name="companyPhone" class="form-control" id="exampleInputEmail1" placeholder="客服电话" style="width: 330px;margin-left: 49px;"></p>
					<p >备注 <input type="text" name="companyRemarks" class="form-control" id="exampleInputEmail1" placeholder="备注信息" style="width: 330px;margin-left: 77px;"></p>
				</div>
			</div>
       
        
      </div>
    </div>
  </div>
  <div class="panel panel-default">
    <div class="panel-heading" role="tab" id="headingTwo">
      <h4 class="panel-title">
        <a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion" href="#collapseTwo" aria-expanded="false" aria-controls="collapseTwo">
          详细信息
        </a>
      </h4>
    </div>
    <div id="collapseTwo" class="panel-collapse collapse" role="tabpanel" aria-labelledby="headingTwo">
      <div class="panel-body">
       	<div class="admin_2_2" style="margin-top: 85px;">
				<div class="admin_2_2_1">
					<p>支付负责人 <img data-toggle="tooltip" data-placement="left" data-original-title="在为你提供服务的过程中，如果遇到任何问题，我们将联系支付负责人。"  src="img/sl24.svg"/></p>
				</div>
				<div class="admin_2_2_2">
					
					<p>姓名 <img data-toggle="tooltip" name="payName" data-placement="left" data-original-title="非常重要！请务必填写真实姓名信息"  src="img/sl24.svg"/> <input type="text" class="form-control" id="exampleInputEmail1" placeholder="姓名" style="width: 330px;margin-left: 57px;"></p>
					<p>身份证号码 <input type="text" name="payID" class="form-control" id="exampleInputEmail1" placeholder="身份证号码" style="width: 330px;margin-left: 35px;"></p>
					<p>常用个人邮箱 <input type="email" name="payEmail" class="form-control" id="exampleInputEmail1" placeholder="个人邮箱" style="width: 330px;margin-left: 21px;"></p>
					<p>常用联系QQ <input type="number" name="payQQ" class="form-control" id="exampleInputEmail1" placeholder="常用QQ号" style="width: 330px;margin-left: 28px;"></p>
					<p>手机号码 <input type="number" name="payPhone" class="form-control" id="exampleInputEmail1" placeholder="手机号码" style="width: 165px;margin-left: 49px;"><a style="position: relative;top: 6px;left: 15px;" href="javascript:void(0);"> 发送校验码</a></p>
					<p>手机验证码 <input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 165px;margin-left: 34px;"></p>
					<p style="margin-left: 110px;">收不到验证码<img data-toggle="tooltip" data-placement="bottom" data-original-title="可能情况：由于您之前退订过某些营销短信，导致运营商对您的号码进行了白名单过滤，因而无法正常接收验证短信。解决方法：1、如果您还有其他常用手机号码，建议更换一个号码。2、拨打业务咨询专线 xxxx-xxx-xxx （09:00 - 19:00 全年无休）进行反馈 "  src="img/sl24.svg"/> </p>
				</div>
			</div>
      </div>
    </div>
  </div>
  <div class="panel panel-default">
    <div class="panel-heading" role="tab" id="headingThree">
      <h4 class="panel-title">
        <a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion" href="#collapseThree" aria-expanded="false" aria-controls="collapseThree">
          联系人信息
        </a>
      </h4>
    </div>
    <div id="collapseThree" class="panel-collapse collapse" role="tabpanel" aria-labelledby="headingThree">
      <div class="panel-body">
       	<div class="admin_2_2" style="margin-top: 85px;">
				<div class="admin_2_2_1">
					<p>支付负责人 <img data-toggle="tooltip" data-placement="left" data-original-title="在为你提供服务的过程中，如果遇到任何问题，我们将联系支付负责人。"  src="img/sl24.svg"/></p>
				</div>
				<div class="admin_2_2_2">
					
					<p>姓名 <img data-toggle="tooltip" name="payName" data-placement="left" data-original-title="非常重要！请务必填写真实姓名信息"  src="img/sl24.svg"/> <input type="text" class="form-control" id="exampleInputEmail1" placeholder="姓名" style="width: 330px;margin-left: 57px;"></p>
					<p>身份证号码 <input type="text" name="payID" class="form-control" id="exampleInputEmail1" placeholder="身份证号码" style="width: 330px;margin-left: 35px;"></p>
					<p>常用个人邮箱 <input type="email" name="payEmail" class="form-control" id="exampleInputEmail1" placeholder="个人邮箱" style="width: 330px;margin-left: 21px;"></p>
					<p>常用联系QQ <input type="number" name="payQQ" class="form-control" id="exampleInputEmail1" placeholder="常用QQ号" style="width: 330px;margin-left: 28px;"></p>
					<p>手机号码 <input type="number" name="payPhone" class="form-control" id="exampleInputEmail1" placeholder="手机号码" style="width: 165px;margin-left: 49px;"><a style="position: relative;top: 6px;left: 15px;" href="javascript:void(0);"> 发送校验码</a></p>
					<p>手机验证码 <input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 165px;margin-left: 34px;"></p>
					<p style="margin-left: 110px;">收不到验证码<img data-toggle="tooltip" data-placement="bottom" data-original-title="可能情况：由于您之前退订过某些营销短信，导致运营商对您的号码进行了白名单过滤，因而无法正常接收验证短信。解决方法：1、如果您还有其他常用手机号码，建议更换一个号码。2、拨打业务咨询专线 xxxx-xxx-xxx （09:00 - 19:00 全年无休）进行反馈 "  src="img/sl24.svg"/> </p>
				</div>
			</div>
      </div>
    </div>
  </div>
  <div class="panel panel-default">
    <div class="panel-heading" role="tab" id="headingFour">
      <h4 class="panel-title">
        <a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion" href="#collapseFour" aria-expanded="false" aria-controls="collapseFour">
          通道信息
        </a>
      </h4>
    </div>
    <div id="collapseFour" class="panel-collapse collapse" role="tabpanel" aria-labelledby="headingFour">
      <div class="panel-body">
       	<div class="admin_2_2" style="margin-top: 85px;">
				<div class="admin_2_2_1">
					<p>支付负责人 <img data-toggle="tooltip" data-placement="left" data-original-title="在为你提供服务的过程中，如果遇到任何问题，我们将联系支付负责人。"  src="img/sl24.svg"/></p>
				</div>
				<div class="admin_2_2_2">
					
					<p>姓名 <img data-toggle="tooltip" name="payName" data-placement="left" data-original-title="非常重要！请务必填写真实姓名信息"  src="img/sl24.svg"/> <input type="text" class="form-control" id="exampleInputEmail1" placeholder="姓名" style="width: 330px;margin-left: 57px;"></p>
					<p>身份证号码 <input type="text" name="payID" class="form-control" id="exampleInputEmail1" placeholder="身份证号码" style="width: 330px;margin-left: 35px;"></p>
					<p>常用个人邮箱 <input type="email" name="payEmail" class="form-control" id="exampleInputEmail1" placeholder="个人邮箱" style="width: 330px;margin-left: 21px;"></p>
					<p>常用联系QQ <input type="number" name="payQQ" class="form-control" id="exampleInputEmail1" placeholder="常用QQ号" style="width: 330px;margin-left: 28px;"></p>
					<p>手机号码 <input type="number" name="payPhone" class="form-control" id="exampleInputEmail1" placeholder="手机号码" style="width: 165px;margin-left: 49px;"><a style="position: relative;top: 6px;left: 15px;" href="javascript:void(0);"> 发送校验码</a></p>
					<p>手机验证码 <input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 165px;margin-left: 34px;"></p>
					<p style="margin-left: 110px;">收不到验证码<img data-toggle="tooltip" data-placement="bottom" data-original-title="可能情况：由于您之前退订过某些营销短信，导致运营商对您的号码进行了白名单过滤，因而无法正常接收验证短信。解决方法：1、如果您还有其他常用手机号码，建议更换一个号码。2、拨打业务咨询专线 xxxx-xxx-xxx （09:00 - 19:00 全年无休）进行反馈 "  src="img/sl24.svg"/> </p>
				</div>
			</div>
      </div>
    </div>
  </div>
  <div class="panel panel-default">
    <div class="panel-heading" role="tab" id="headingFive">
      <h4 class="panel-title">
        <a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion" href="#collapseFive" aria-expanded="false" aria-controls="collapseFive">
          收款结算账户信息
        </a>
      </h4>
    </div>
    <div id="collapseFive" class="panel-collapse collapse" role="tabpanel" aria-labelledby="headingFive">
      <div class="panel-body">
       	<div class="admin_2_2" style="margin-top: 85px;">
				<div class="admin_2_2_1">
					<p>支付负责人 <img data-toggle="tooltip" data-placement="left" data-original-title="在为你提供服务的过程中，如果遇到任何问题，我们将联系支付负责人。"  src="img/sl24.svg"/></p>
				</div>
				<div class="admin_2_2_2">
					
					<p>姓名 <img data-toggle="tooltip" name="payName" data-placement="left" data-original-title="非常重要！请务必填写真实姓名信息"  src="img/sl24.svg"/> <input type="text" class="form-control" id="exampleInputEmail1" placeholder="姓名" style="width: 330px;margin-left: 57px;"></p>
					<p>身份证号码 <input type="text" name="payID" class="form-control" id="exampleInputEmail1" placeholder="身份证号码" style="width: 330px;margin-left: 35px;"></p>
					<p>常用个人邮箱 <input type="email" name="payEmail" class="form-control" id="exampleInputEmail1" placeholder="个人邮箱" style="width: 330px;margin-left: 21px;"></p>
					<p>常用联系QQ <input type="number" name="payQQ" class="form-control" id="exampleInputEmail1" placeholder="常用QQ号" style="width: 330px;margin-left: 28px;"></p>
					<p>手机号码 <input type="number" name="payPhone" class="form-control" id="exampleInputEmail1" placeholder="手机号码" style="width: 165px;margin-left: 49px;"><a style="position: relative;top: 6px;left: 15px;" href="javascript:void(0);"> 发送校验码</a></p>
					<p>手机验证码 <input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 165px;margin-left: 34px;"></p>
					<p style="margin-left: 110px;">收不到验证码<img data-toggle="tooltip" data-placement="bottom" data-original-title="可能情况：由于您之前退订过某些营销短信，导致运营商对您的号码进行了白名单过滤，因而无法正常接收验证短信。解决方法：1、如果您还有其他常用手机号码，建议更换一个号码。2、拨打业务咨询专线 xxxx-xxx-xxx （09:00 - 19:00 全年无休）进行反馈 "  src="img/sl24.svg"/> </p>
				</div>
			</div>
      </div>
    </div>
  </div>
  <div class="panel panel-default">
    <div class="panel-heading" role="tab" id="headingSix">
      <h4 class="panel-title">
        <a class="collapsed" role="button" data-toggle="collapse" data-parent="#accordion" href="#collapseSix" aria-expanded="false" aria-controls="collapseSix">
          证照信息
        </a>
      </h4>
    </div>
    <div id="collapseSix" class="panel-collapse collapse" role="tabpanel" aria-labelledby="headingSix">
      <div class="panel-body" style="padding-bottom: 50px;">
      	<div class="admin_2_3" style="height: 550px;margin-top: 75px;">
				<div class="admin_2_3_1">
					<p>证件文件</p>
				</div>
				<div class="admin_2_3_2">
					<p style="margin-top: 16px;">公司营业执照副本 <img data-toggle="tooltip" data-placement="right" data-original-title="如三证合一（营业执照、组织机构代码证、税务登记证），请您在相应位置均提交营业执照。"  src="img/sl24.svg"/> </p>
					<p><a href="javascript:;" class="a-upload1"><input type="file" name="yingYe" id="">点击选择上传文件</a><span style="margin-left: 20px;position: relative;top: -4px;color: brown;" class="showFileName1"></span><span style="margin-left: 20px;position: relative;top: -4px;color: brown;" class="fileerrorTip1"></span></p>
					<p style="color: #999;margin-bottom: 30px;">* 彩色无水印 、png或者jpg格式 、2M以内 </p>
					
					<p>组织机构代码证 <img data-toggle="tooltip" data-placement="right" data-original-title="如三证合一（营业执照、组织机构代码证、税务登记证），请您在相应位置均提交营业执照。"  src="img/sl24.svg"/> </p>
					<p><a href="javascript:;" class="a-upload2"><input type="file" name="zuZhi" id="">点击选择上传文件</a><span style="margin-left: 20px;position: relative;top: -4px;color: brown;" class="showFileName2"></span><span style="margin-left: 20px;position: relative;top: -4px;color: brown;" class="fileerrorTip2"></span></p>
					<p style="color: #999;margin-bottom: 30px;">* 彩色无水印 、png或者jpg格式 、2M以内 </p>
					
					<p>身份证件 </p>
					<p><a href="javascript:;" class="a-upload3"><input type="file" name="shenFen" id="">点击选择上传文件</a><span style="margin-left: 20px;position: relative;top: -4px;color: brown;" class="showFileName3"></span><span style="margin-left: 20px;position: relative;top: -4px;color: brown;" class="fileerrorTip3"></span></p>
					<p style="color: #999;margin-bottom: 30px;">* 彩色无水印 、png或者jpg格式 、2M以内 </p>
					
					<p>合同扫描图片  </p>
					<p><a href="javascript:;" class="a-upload4"><input type="file" name="heTong" id="">点击选择上传文件</a><span style="margin-left: 20px;position: relative;top: -4px;color: brown;" class="showFileName4"></span><span style="margin-left: 20px;position: relative;top: -4px;color: brown;" class="fileerrorTip4"></span></p>
					<p style="color: #999;margin-bottom: 30px;">* 彩色无水印 、png或者jpg格式 、2M以内 </p>
					
				</div>
				<p style="padding-left: 34%;"><input id="fukuan" class="btn btn-default" type="submit" style="padding: 7px 68px;margin-bottom: 50px;" value="提交" /></p>
			</div>

      </div>
    </div>-->
    
    
    <table border="0">
								<tbody class="tbody">
									<p style="text-align: center;">基本信息</p>
								<tr>
									<td style="width: 190px;text-align: center;"> 商户名称 </td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="商户名称" style="width: 265px;margin-left: 10px;"> <span style=""> *</span></td>
									<td style="width: 190px;text-align: center;">商户简称</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="商户简称" style="width: 265px;margin-left: 10px;"> <span style=""> *</span></td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 开通类型</td>
									<td>
										<select style="height: 40px;" name="cars" >
											<option selected="">-请选择-</option>
											<option value="100">已发送</option>
											<option value="101">未发送</option>
											<!--<option value="102" >&nbsp;&nbsp;等待</option>-->
										</select>
										<span style=""> *</span>
									</td>
									<td style="width: 190px;text-align: center;">默认关注公众号appid</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"></</td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 备注</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"></</td>
									<td style="width: 190px;text-align: center;"></td>
									<td></td>
								</tr>
								</tbody>
							</table>
							
							
							 <table border="0">
								<tbody class="tbody">
									<p style="text-align: center;">详细信息</p>
									
								<tr>
									
									<td style="width: 190px;text-align: center;"> 所在省份</td>
									<td>
										<select style="height: 40px;" id="s_province" name="s_province"></select> <span style=""> *</span>
									</td>
									<td style="width: 190px;text-align: center;">所在城市</td>
									<td><select style="height: 40px;" id="s_city" name="s_city" ></select> <span style=""> *</span></td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 所在区/县</td>
									<td><select style="height: 40px;" id="s_county" name="s_county"></select><span style=""> *</span></td>
									<td style="width: 190px;text-align: center;">详细地址</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入详细地址" style="width: 265px;margin-left: 10px;"> <span style=""> *</span></td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 注册地址</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入公司注册地址" style="width: 265px;margin-left: 10px;"></</td>
									<td style="width: 190px;text-align: center;">商户传真号</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入商户传真号" style="width: 265px;margin-left: 10px;"></</td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 客服电话</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入客服电话" style="width: 265px;margin-left: 10px;"><span style=""> *</span></td>
									<td style="width: 190px;text-align: center;">营业面积</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="单位平方米" style="width: 265px;margin-left: 10px;"></</td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 运行者姓名</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入运行者姓名" style="width: 265px;margin-left: 10px;"></</td>
									<td style="width: 190px;text-align: center;">运行者身份证号码</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入运行者身份证号码" style="width: 265px;margin-left: 10px;"></</td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 网址</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入网址" style="width: 265px;margin-left: 10px;"></</td>
									<td style="width: 190px;text-align: center;">网址域名</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入网站域名" style="width: 265px;margin-left: 10px;"></</td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> ICP备案号</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入ICP备案号" style="width: 265px;margin-left: 10px;"></</td>
									<td style="width: 190px;text-align: center;">是否报备微信</td>
									<td>
										<select name="cars" style="height: 40px;" >
											<option selected="">-请选择-</option>
											<option value="100">已发送</option>
											<option value="101">未发送</option>
											<!--<option value="102" >&nbsp;&nbsp;等待</option>-->
										</select>
										<span style=""> *</span>
									</td>
								</tr>
								
								</tbody>
							</table>
							
							 <table border="0">
								<tbody class="tbody">
									<p style="text-align: center;">联系人信息</p>
								<tr>
									<td style="width: 190px;text-align: center;"> 联系人</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"><span style=""> *</span></td>
									<td style="width: 190px;text-align: center;">联系人邮箱</td>
									<td><input type="email" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"><span style=""> *</span></td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 联系人固话</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"></</td>
									<td style="width: 190px;text-align: center;">联系人手机</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"><span style=""> *</span></td>
								</tr>					
								</tbody>
							</table>
							
							 <table border="0">
								<tbody class="tbody">
									<p style="text-align: center;">通道信息</p>
								<tr>
									<td style="width: 190px;text-align: center;"> 微信通道信息</td>
									<td>
										<select style="height: 40px;" name="cars" >
											<option selected="">-请选择-</option>
											<option value="100">已发送</option>
											<option value="101">未发送</option>
											<!--<option value="102" >&nbsp;&nbsp;等待</option>-->
										</select>
										<span style=""> *</span>
									</td>
									<td style="width: 190px;text-align: center;">支付宝通道信息</td>
									<td>
										<select style="height: 40px;" name="cars" >
											<option selected="">-请选择-</option>
											<option value="100">已发送</option>
											<option value="101">未发送</option>
											<!--<option value="102" >&nbsp;&nbsp;等待</option>-->
										</select>
										<span style=""> *</span>
									</td>
								</tr>
								
								
								</tbody>
							</table>
							
							 <table border="0">
								<tbody class="tbody">
									<p style="text-align: center;">收款结算账户信息</p>
								<tr>
									<td style="width: 190px;text-align: center;"> 开户名称</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"><span style=""> *</span></td>
									<td style="width: 190px;text-align: center;">银行卡号</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"><span style=""> *</span></td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 开户银行</td>
									<td>
										<select style="height: 40px;" id="sel">
											<option value="">选择开户银行</option>
											<option value="国家开发银行">国家开发银行</option>
              								<option value="中国进出口银行">中国进出口银行</option>
              								<option value="中国农业发展银行">中国农业发展银行</option>
              								<option value="中国银行">中国银行</option>
              								<option value="中国工商银行">中国工商银行</option>
              								<option value="中国建设银行">中国建设银行</option>
              								<option value="中国农业银行">中国农业银行</option>
              								<option value="中国光大银行">中国光大银行</option>
              								<option value="中国民生银行">中国民生银行</option>
              								<option value="中信银行">中信银行</option>
              								<option value="交通银行">交通银行</option>
              								<option value="华夏银行">华夏银行</option>
              								<option value="招商银行">招商银行</option>
              								<option value="兴业银行">兴业银行</option>
              								<option value="广发银行">广发银行</option>
              								<option value="平安银行">平安银行</option>
              								<option value="上海浦东发展银行">上海浦东发展银行</option>
              								<option value="恒丰银行">恒丰银行</option>
              								<option value="浙商银行">浙商银行</option>
              								<option value="渤海银行">渤海银行</option>
              								<option value="中国邮政储蓄银行">中国邮政储蓄银行</option>
              								<option value="城市商业银行">城市商业银行</option>
              								<option value="北京银行">北京银行</option>
              								<option value="天津银行">天津银行</option>
              								<option value="河北银行">河北银行</option>
              								<option value="沧州银行">沧州银行</option>
              								<option value="唐山市商业银行">唐山市商业银行</option>
              								<option value="承德银行">承德银行</option>
              								<option value="张家口市商业银行">张家口市商业银行</option>
              								<option value="秦皇岛银行">秦皇岛银行</option>
              								<option value="广东发展银行">广东发展银行</option>
              								<option value="深圳发展银行">深圳发展银行</option>
              								<option value="邢台银行">邢台银行</option>
              								<option value="廊坊银行">廊坊银行</option>
              								<option value="保定银行">保定银行</option>
              								<option value="邯郸银行">邯郸银行</option>
              								<option value="衡水银行">衡水银行</option>
              								<option value="晋商银行">晋商银行</option>
              								<option value="大同市商业银行">大同市商业银行</option>
              								<option value="长治银行">长治银行</option>
              								<option value="其他</">其他</option>
										</select>
										<span style=""> *</span>
									</td>
									<td style="width: 190px;text-align: center;">账户类型</td>
									<td>
										<select style="height: 40px;" name="cars" >
											<option selected="">中信银行内部账户</option>
											<option value="100">已发送</option>
											<option value="101">未发送</option>
											<!--<option value="102" >&nbsp;&nbsp;等待</option>-->
										</select>
									</td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 开户省份</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入开户省份" style="width: 265px;margin-left: 10px;"></</td>
									<td style="width: 190px;text-align: center;">开户城市</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入开户城市" style="width: 265px;margin-left: 10px;"></</td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 开户支行</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入开户支行名称" style="width: 265px;margin-left: 10px;"><span style=""> *</span></td>
									<td style="width: 190px;text-align: center;">支付联行号</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入支付联行号" style="width: 265px;margin-left: 10px;"><span style=""> *</span></td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 手续费扣款方式</td>
									<td>
										<select style="height: 40px;" name="cars" >
											<option selected="">-请选择-</option>
											<option value="100">已发送</option>
											<option value="101">未发送</option>
											<!--<option value="102" >&nbsp;&nbsp;等待</option>-->
										</select>
										<span style=""> *</span>
									</td>
									<td style="width: 190px;text-align: center;"></td>
									<td></td>
								</tr>
								
								
								</tbody>
							</table>
							
							 <table border="0">
								<tbody class="tbody">
									<p style="text-align: center;">证照信息</p>
								<tr>
									<td style="width: 190px;text-align: center;"> 法人姓名</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="输入法人姓名" style="width: 265px;margin-left: 10px;"></</td>
									<td style="width: 190px;text-align: center;">法人证件类型</td>
									<td>
										<select style="height: 40px;" name="cars" >
											<option selected="">-请选择-</option>
											<option value="100">已发送</option>
											<option value="101">未发送</option>
											<!--<option value="102" >&nbsp;&nbsp;等待</option>-->
										</select>
									</td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 法人证件号</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"></</td>
									<td style="width: 190px;text-align: center;"></td>
									<td></td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 协议编号</td>
									<td><input type="text" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"></</td>
									<td style="width: 190px;text-align: center;">协议到期日期：</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"></</td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 商户证件类型</td>
									<td>
										<select style="height: 40px;" name="cars" >
											<option selected="">-请选择-</option>
											<option value="100">已发送</option>
											<option value="101">未发送</option>
											<!--<option value="102" >&nbsp;&nbsp;等待</option>-->
										</select>
									</td>
									<td style="width: 190px;text-align: center;">商户证件号</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"></</td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 税务登记证号</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"></</td>
									<td style="width: 190px;text-align: center;">组织机构代码</td>
									<td><input type="number" name="payVerification" class="form-control" id="exampleInputEmail1" placeholder="手机验证码" style="width: 265px;margin-left: 10px;"></</td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 协议扫描图片</td>
									<td><p ><a href="javascript:;" class="a-upload1"><input style="width: 150px;" type="file" name="yingYe" id="">选择上传文件</a><span style="margin-left: 20px;position: relative;top: -4px;color: brown;font-size: 12px;" class="showFileName1"></span><span style="margin-left: 20px;position: relative;top: -4px;color: brown;" class="fileerrorTip1"></span></p></td>
									<td style="width: 190px;text-align: center;">法人证件图片</td>
									<td><p><a href="javascript:;" class="a-upload2"><input style="width: 150px;" type="file" name="zuZhi" id="">选择上传文件</a><span style="margin-left: 20px;position: relative;top: -4px;color: brown;font-size: 12px;" class="showFileName2"></span><span style="margin-left: 20px;position: relative;top: -4px;color: brown;font-size: 13px;" class="fileerrorTip2"></span></p></td>
								</tr>
								<tr>
									<td style="width: 190px;text-align: center;"> 商户证件图片</td>
									<td><p><a href="javascript:;" class="a-upload3"><input style="width: 150px;" type="file" name="shenFen" id="">选择上传文件</a><span style="margin-left: 20px;position: relative;top: -4px;color: brown;font-size: 12px;" class="showFileName3"></span><span style="margin-left: 20px;position: relative;top: -4px;color: brown;font-size: 13px;" class="fileerrorTip3"></span></p></td>
									<td style="width: 190px;text-align: center;">组织机构图片</td>
									<td><p><a href="javascript:;" class="a-upload4"><input style="width: 150px;" type="file" name="heTong" id="">选择上传文件</a><span style="margin-left: 20px;position: relative;top: -4px;color: brown;font-size: 12px;" class="showFileName4"></span><span style="margin-left: 20px;position: relative;top: -4px;color: brown;font-size: 13px;" class="fileerrorTip4"></span></p></td>
								</tr>
								</tbody>
							</table>
							
							<p style="padding-left: 43%;"><input id="fukuan" class="btn btn-default" type="submit" style="padding: 7px 68px;margin-bottom: 10px;margin-top: 30px;" value="提交" /></p>
							<!--<p style="text-align: center; color: #656565;margin-bottom: 50px;font-size: 13px;" >* 点击查看 <a href="protocol.html">移动支付协议</a>  详情！ 	</p>-->
  </div>
</div>



			 
     
			
			
			
			
			
			
			</form>
		</div>
	</body>
</html>
